Householder Application for Planning Permission for works or extension to a dwelling.

Town and Country Planning Act 1990

Publication of applications on planning authority websites. Please note that the information provided on this application form and in supporting documents may be published on the Authority’s website. If you require any further clarification, please contact the Authority’s planning department.

1. Applicant Name, Address and Contact Details

| Title: | Mr | First Name: | Mark | Surname: | Staniland | |--------|----|-------------|------|----------|-----------| | Company name: | | | | | | | Street address: | 16, Gorse Ridge Drive | | | | | | Telephone number: | | | | | | | Mobile number: | | | | | | | Town/City: | BASLOW | | | | | | Country: | | | | | | | Postcode: | DE45 1SL | | | | |

Are you an agent acting on behalf of the applicant?\
☐ Yes ☐ No

2. Agent Name, Address and Contact Details

| Title: | Mr | First Name: | Benjamin | Surname: | Smith | |--------|----|-------------|----------|----------|-------| | Company name: | | | | | | | Street address: | 30 Southview Crescent | | | | | | Telephone number: | | | | | 07791213178 | | Mobile number: | | | | | | | Town/City: | SHEFFIELD | | | | | | Country: | | | | | | | Postcode: | S7 1DH | | | | bensmith_000@hotmail.com |

3. Description of Proposed Works

Please describe the proposed works: Replacement windows and doors/Internal alterations/extension to front elevation forming new porch

Has the work already been started without planning permission?\
☐ Yes ☐ No 4. Site Address Details

Full postal address of the site (including full postcode where available)

| Description: | |--------------|

| House: | 16 | |--------|----| | Suffix: | | | House name: | | | Street address: | Gorse Ridge Drive | | Town/City: | BASLOW | | Postcode: | DE45 1SL |

Description of location or a grid reference (must be completed if postcode is not known):

| Easting: | 425085 | |----------|--------| | Northing: | 372785 |

5. Pedestrian and Vehicle Access, Roads and Rights of Way

Is a new or altered vehicle access proposed to or from the public highway? Yes No

Is a new or altered pedestrian access proposed to or from the public highway? Yes No

Do the proposals require any diversions, extinguishment and/or creation of public rights of way? Yes No

6. Pre-application Advice

Has assistance or prior advice been sought from the local authority about this application? Yes No

7. Trees and Hedges

Are there any trees or hedges on your own property or on adjoining properties which are within falling distance of your proposed development? Yes No

Will any trees or hedges need to be removed or pruned in order to carry out your proposal? Yes No

8. Parking

Will the proposed works affect existing car parking arrangements? Yes No

9. Authority Employee/Member

With respect to the Authority, I am:

(a) a member of staff (b) an elected member (c) related to a member of staff (d) related to an elected member

Do any of these statements apply to you? Yes No

10. Site Visit

Can the site be seen from a public road, public footpath, bridleway or other public land? Yes No 10. Site Visit

If the planning authority needs to make an appointment to carry out a site visit, whom should they contact? (Please select only one)

- The agent
- The applicant
- Other person

11. Materials

Please state what materials (including type, colour and name) are to be used externally (if applicable):

**Doors - description:** Description of existing materials and finishes:

- Upvc

Description of proposed materials and finishes:

- Colour to match

**Roof - description:** Description of existing materials and finishes:

- Tiles

Description of proposed materials and finishes:

- Tiles to match existing

**Walls - description:** Description of existing materials and finishes:

- Stone

Description of proposed materials and finishes:

- Stone to match existing

**Windows - description:** Description of existing materials and finishes:

- Upvc

Description of proposed materials and finishes:

- Colour to match

Are you supplying additional information on submitted plan(s)/drawing(s)/design and access statement?

- Yes
- No

If Yes, please state references for the plan(s)/drawing(s)/design and access statement:

- associated drawings

12. Certificates (Certificate A)

Certificate of Ownership - Certificate A Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14

I certify/The applicant certifies that on the day 21 days before the date of this application nobody except myself/the applicant was the owner (owner is a person with a freehold interest or leasehold interest with at least 7 years left to run) of any part of the land to which the application relates, and that none of the land to which the application relates is, or is part of, an agricultural holding ("agricultural holding" has the meaning given by reference to the definition of "agricultural tenant" in section 65(8) of the Act).

Title: Mr\
First name:\
Surname: Smith\
Person role: AGENT\
Declaration date: 29/11/2016\
Declaration made

13. Declaration

I/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional information. I/we confirm that, to the best of my/our knowledge, any facts stated are true and accurate and any opinions given are the genuine opinions of the person(s) giving them.

Date 29/11/2016